EVIDENCE-BASED STRATEGIES TO DELIVER AND PROMOTE AGE-FRIENDLY CARE IN HOSPITAL SETTINGS

Abstract The number of adults aged 65 and older will double by 2050. Older adults have more chronic conditions and complex care needs compared to younger adults. To support the health of older adults the Age Friendly Health Systems model was initiated in the US. Age Friendly Care is comprised of 4 core elements (called the 4 M’s framework), What Matters, Medication, Mentation and Mobility, aimed to ensure that older adults receive the best care possible and are not harmed by health care systems. This symposium will present several papers describing how components of age friendly care were implemented in hospital settings. Paper 1 will describe strategies used by acute care nursing staff to overcome challenges imposed by COVID to implement a mobility intervention to improve ambulation of older adult patients; Paper 2 will present psychometric findings on an instrument to measure a patient’s level of ambulation to promote mobility during a hospital stay; Paper 3 will describe a quality improvement initiative to implement the 4 M’s framework on in-patient medical units; and Paper 4 will provide insights on implementing the What Matters component of 4 M care and strategies for promoting patient goals and preferences for care delivery. Age-Friendly Health Systems have the potential to improve care delivery for older adults. The papers presented demonstrate it is feasible to implement 4 M’s framework in hospitals, but innovative strategies and reliable tools are needed.

opportunities.Preliminary regression results show that coresidence is substantially less likely in areas with higher availability of nursing care and continuing care options.Among non-coresidents, living in close proximity (distances under 10 miles) is less likely if parent's area has more nursing care options, but more likely if health services that support living in place are available.Additionally, local economic and housing conditions play a role, with higher median household income associated with children living closer to parents and higher cost of rent with living further.Place-specific characteristics are important determinants of parent-child coresidence and proximity, and policymakers and care providers should consider them when determining the most effective ways to support older adults who need care.Limited research has examined the association between formal social participation trajectories and end-of-life care quality.The end of life could be characterized by experiences of heightened feelings of physical and psychological distress, breathlessness, constant hospitalization, and intrusive interventions.Formal social participation may improve the end-of-life care of older adults because they serve as sources of useful information, receipt of emotional support, and improve self-efficacy.This research examines the associations between formal social participation trajectories and proxy ratings of overall end-of-life care quality, and the moderating role of gender.Growth-based trajectory models were used to identify distinct developmental trajectories of formal social participation among older adults in the United States.Findings revealed four social participation trajectory classes among older adults towards the end of life, all with a general tendency to decline across time.Multinomial logistic regression analyses showed that although older adults with higher levels of formal social participation have more positive overall end-of-life care ratings, there are gender differences in these care ratings.Women are less likely than men to chart, by proxy report, positive care ratings at the end of life even though they have higher levels of formal social participation, and these gender differences in end-of-life care rating are explained more by healthcare factors than formal social participation trajectories.These results suggest that both formal social participation and positive interactions with health care at the end of life are more beneficial for older men than women.

EVIDENCE-BASED STRATEGIES TO DELIVER AND PROMOTE AGE-FRIENDLY CARE IN HOSPITAL SETTINGS
Chair: Barbara King Co-Chair: Mary Hook Discussant: Blair Golden The number of adults aged 65 and older will double by 2050.Older adults have more chronic conditions and complex care needs compared to younger adults.To support the health of older adults the Age Friendly Health Systems model was initiated in the US.Age Friendly Care is comprised of 4 core elements (called the 4 M's framework), What Matters, Medication, Mentation and Mobility, aimed to ensure that older adults receive the best care possible and are not harmed by health care systems.This symposium will present several papers describing how components of age friendly care were implemented in hospital settings.Paper 1 will describe strategies used by acute care nursing staff to overcome challenges imposed by COVID to implement a mobility intervention to improve ambulation of older adult patients; Paper 2 will present psychometric findings on an instrument to measure a patient's level of ambulation to promote mobility during a hospital stay; Paper 3 will describe a quality improvement initiative to implement the 4 M's framework on in-patient medical units; and Paper 4 will provide insights on implementing the What Matters component of 4 M care and strategies for promoting patient goals and preferences for care delivery.Age-Friendly Health Systems have the potential to improve care delivery for older adults.The papers presented demonstrate it is feasible to implement 4 M's framework in hospitals, but innovative strategies and reliable tools are needed.

INSIGHTS ON THE CLINICAL NURSE ROLE IN IMPLEMENTING WHAT MATTERS FOR OLDER ADULTS IN ACUTE CARE
Murad Taani 1 , and Mary Hook 2 , 1. University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States, 2. Advocate Health, Milwaukee, Wisconsin, United States The Age-Friendly Health System (AFHS) evidence-based 4Ms framework (What Matters, Medication, Mentation, & Mobility) is designed to be implemented in clinical settings to reliably provide high-quality age-friendly care to older adults and reduce harm and hospital-associated complications.The 4M concept of 'What Matters to You' (WMTY) refers to assessing and aligning an individual's specific health outcome goals and care preferences to ensure patientcentered care with a measurable impact on patient experience.While published toolkits support the implementation of WMTY for all disciplines, there is limited guidance and empirical evidence about the implementation and impact of this concept when used by clinical nurses in acute care.Some researchers have identified issues with implementing WMTY with patients who are not able to articulate their wishes or when the question is posed in a granular way.A large healthcare system in the Midwest supported five hospitals to implement the AFHS 4Ms including the WMTY concept but did not observe an improvement in nursesensitive patient experience measures.A qualitative study is in progress aimed at gaining an in-depth understanding of the knowledge, perceptions, and experiences of leaders and clinical nurses who have implemented the WMTY concept for older adults in their hospital to evaluate the implementation and impact on patient care.The results gathered by this study will lay the foundation for designing clinical nursetargeted interventions to successfully implement WMTY and identifying supportive strategies for partnering with patients and their caregivers to ensure that their goals/preferences are fully integrated into care.

VALIDATING THE IMPACT OF THE COMPREHENSIVE MOBILITY EVALUATION TOOL USED BY NURSES IN ACUTE CARE
Mary Hook, Advocate Health, Milwaukee, Wisconsin, United States Existing nursing-based mobility tools were developed with clinical and reliability testing with small samples; none focused on predicting assistance needs.The Comprehensive Mobility Evaluation Tool (CMET) was designed using established testing procedures to support nurses to assess all phases of mobilization and predict level of assistance.A prospective descriptive research design was used to test reliability and validate CMET items, scoring, and ability to predict LOA.A randomly selected sample of decisional/English-speaking non-ventilated stable patients were enrolled from four medical/surgical and one critical care units at a large community hospital where CMET was used.Trained data collectors consented patients, completed bedside testing, and distributed patient surveys.Descriptive, inferential, and regression statistics were used for analysis.The representative sample (N=190) had an average age of 67.3 yrs (SD=16.2,23-101), 50% male, with a robust range of mobility levels.Inter-rater reliability (n=27) yielded an average kappa of 0.94.Six of seven steps contributed significantly to predicting patient LOA with scores that correlated with nurse judgement [r (184) =0.86, p< .0001].Patients needed time and support to perform testing without assistance for optimal accuracy and benefit.Patients reported CMET was useful (88%) and easy (62%) and identified barriers that limit walking while hospitalized.Study limited by research at a single site.This study represents the initial validation, confirming reliability and benefits of the CMET, a skill-based tool to evaluate mobility status.Providing time and encouragement to perform CMET helps nurses and patients to identify deficits and tailor care to overcome mobility barriers.

MOVIN PAST OBSTACLES: BUILDING A CULTURE OF MOBILITY
Sarah Glowinski 1 , Mary Hook 1 , and Barbara King 2 , 1. Advocate Health, Milwaukee, Wisconsin, United States, 2. University of Wisconsin-Madison, Madison, Wisconsin, United States Older adults are at risk for losing their ability to ambulate independently during hospitalization.The "MOVIN" (Mobilizing Older adult patients Via a systems-based Intervention) Study is a cluster-randomized control trial aimed to implement a nursing-led mobility model and monitor the change in nurse behaviors and unit culture before, during and after the 14-week intervention period.The model includes psychomotor training, mobility resources (equipment and ambulation aide), communication tools, ambulation pathways, and support for developing a "culture of mobility" led by nurses.